Effects of transcranial direct current stimulation and acetazolamide consumption on the balance of active mountaineers in simulated altitude

Document Type : Research Paper

Authors

1 Razi University, Kermanshah, Iran

2 Federal University of Rio Grande do Norte

Abstract
Objectives: Balance is an important factor for the success and health of mountaineers. This study aimed to investigate the separate and combined effects of electrical brain stimulation and acetazolamide on the balance of male mountaineers.
Methods & Materials: 12 male mountaineers (mean±standard deviasion of age, height, and weight was respectively: 39.8±4.6 years, 177.4±7.8 cm, and 79.1±1.9 kg) participated in this double-blind study. Participants were exposed to six conditions: 1)Acetazolamide-M1 stimulation 2)Acetazolamide-DLPFC stimulation 3)Acetazolamide-sham 4)Placebo-M1 5)Placebo-DLPFC 6)Placebo-sham. In each session, subjects received 20 minutes of brain stimulation, after being exposed to 30 minutes of hypoxia (O2=13%) in a sitting position. Then, participants performed an endurance-exhausting task at 60% of maximal aerobic speed on the treadmill, considering their aerobic endurance. Immediately after the task, the balances of the supporting and nonsupporting legs were measured. The two-way repeated measures ANOVA was used for statistical analysis.
Results: In hypoxic conditions, stimulation of the M1 and DLPFC regions had a significant positive effect on the balance of the supporting leg compared to the sham stimulation conditions (p=0.02 and p=0.03, respectively). However, there was no significant difference between these two types of stimulation. For the nonsupporting leg, no significant difference was observed between the stimulation conditions in different areas. In addition, no significant difference was seen between the use of acetazolamide and sham on the balance of the supporting and nonsupporting legs.
Conclusions: Stimulation of the M1 and DLPFC areas can improve the balance of the supporting leg of mountaineers during high-altitude climbing.

Keywords

Main Subjects

  1. Cheung SS, Ainslie PN. Advanced environmental exercise physiology. Champaign: Human Kinetics; 2022.
  2. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physio Rev.
    2012; 92:1651-97    .
  3. Debenham MI, Smuin JN, Grantham TD, Ainslie PN, Dalton BH. Hypoxia and standing balance. Eur J Appl Physiol. 2021;121: 993-1008.
  4. Delliaux S, Jammes Y. Effects of hypoxia on muscle response to tendon vibration in humans. Muscle Nerve Suppl. 2006;34(6):754-61.
  5. Hackett PH, Roach RC. High-altitude illness. Med. 2001;345(2):107-14.
  6. Davis C, Hackett P. Advances in the prevention and treatment of high-altitude illness. Emerg Med Clin. 2017;35(2):241-60.
  7. Swenson ER. Carbonic anhydrase inhibitors and ventilation: a complex interplay of stimulation and suppression. Eur Respir J. 1998;12(6):1242-7.
  8. Buergin A, Furian M, Mayer L, Lichtblau M, Scheiwiller PM, Sheraliev U, et al. Effect of acetazolamide on postural control in patients with COPD travelling to 3100 m randomized trial. J Clin Med. 2023;12(4):1246.
  9. Davis NJ. Neurodoping: brain stimulation as a performance-enhancing measure. Sports Med. 2013;43:649-53.
  10. Stagg CJ, Jayaram G, Pastor D, Kincses ZT, Matthews PM, Johansen-Berg H. Polarity and timing-dependent effects of transcranial direct current stimulation in explicit motor learning. Neuro. 2011;49(5):800-4.
  11. Nitsche MA, Liebetanz D, Antal A, Lang N, Tergau F, Paulus W. Modulation of cortical excitability by weak direct current stimulation–technical, safety and functional aspects. Suppl Clin Neurophysiol. 2003;56:255-76.
  12. Clark VP, Coffman BA, Trumbo MC, Gasparovic C. Transcranial direct current stimulation (tDCS) produces localized and specific alterations in neurochemistry: a 1H magnetic resonance spectroscopy study. Neurosci Lett. 2011;500(1):67-71.
  13. Shiozawa P, da Silva ME, Cordeiro Q, Fregni F, Brunoni AR. Transcranial direct current stimulation (tDCS) for the treatment of persistent visual and auditory hallucinations in schizophrenia: a case study. Brain Stimul: Basic, Translational, and Clinical Research in Neuromodulation. 2013;6(5):831-3.
  14. Soff C, Sotnikova A, Christiansen H, Becker K, Siniatchkin M. Transcranial direct current stimulation improves clinical symptoms in adolescents with attention deficit hyperactivity disorder. J Neural Transm. 2017; 124:133-44.
  15. de Moura MC, Hazime FA, Marotti Aparicio LV, Grecco LA, Brunoni AR, Hasue RH. Effects of transcranial direct current stimulation (tDCS) on balance improvement: a systematic review and meta-analysis. Somatosens Mot Res. 2019;36(2):122-35.
  16. Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000;527(Pt 3):633.
  17. Takakusaki K. Functional neuroanatomy for posture and gait control. J Mov Disord. 2017;10(1):1.
  18. Grecco LA, Duarte NA, Zanon N, Galli M, Fregni F, Oliveira CS. Effect of a single session of transcranial direct-current stimulation on balance and spatiotemporal gait variables in children with cerebral palsy: a randomized sham-controlled study. Braz J Phys Ther. 2014; 18:419-27.
  19. Etemadi M, Amiri E, Tadibi V, Grospretre S, Valipour Dehnou V, Da Silva Machado DG. Effect of Transcranial Direct Current Stimulation on Dynamic Balance after Endurance Exhausting Activity in Normobaric Hypoxia. J Appl Exer Physiol. 2022;18(35):5-6. (In Persian).
  20. Schmickl CN, Owens RL, Orr JE, Edwards BA, Malhotra A. Side effects of acetazolamide: a systematic review and meta-analysis assessing overall risk and dose dependence. BMJ Open Respir Res. 2020;7(1): e000557.

 

  1. Collier DJ, Wolff CB, Hedges AM, Nathan J, Flower RJ, Milledge JS, Swenson ER. Benzolamide improves oxygenation and reduces acute mountain sickness during a high‐altitude trek and has fewer side effects than acetazolamide at sea level. Pharmacol. Res. Perspect. 2016;4(3):e00203
  2. Machado FA, Kravchychyn AC, Peserico CS, da Silva DF, Mezzaroba PV. Incremental test design, peak ‘aerobic’running speed and endurance performance in runners. Journal of Science and Medicine in Sport. 2013;16(6):577-82.
  3. Grosprêtre S, Grandperrin Y, Nicolier M, Gimenez P, Vidal C, Tio G, Haffen E et al. Effect of transcranial direct current stimulation on the psychomotor, cognitive, and motor performances of power athletes. Sci Repo. 2021;11(1):9731.
  4. Kessler SK, Turkeltaub PE, Benson JG, Hamilton RH. Differences in the experience of active and sham transcranial direct current stimulation. Brain Stimul. 2012;5(2):155-62.
  5. Banaei P, Tadibi V, Amiri E, Machado DGDS. Concomitant dual-site tDCS and dark chocolate improve cognitive and endurance performance following cognitive effort under hypoxia: a randomized controlled trial. Sci Rep. 2023;13(1):16473.
  6. Etemadi M, Amiri E, Tadibi V, Grospretre S, Valipour Dehnou V, Machado DGDS. Anodal tDCS over the left DLPFC but not M1 increases muscle activity and improves psychophysiological responses, cognitive function, and endurance performance in normobaric hypoxia: a randomized controlled trial. BMC Neurosci. 2023;24(1):25.
  7. Buchanan DM, Bogdanowicz T, Khanna N, Lockman-Dufour G, Robaey P, D'Angiulli A. Systematic Review on the Safety and Tolerability of Transcranial Direct Current Stimulation in Children and Adolescents. Brain Sci. 2021;11(2):212.
  8. Clarke SB, Deighton K, Newman C, Nicholson G, Gallagher L, Boos CJ et al. Changes in balance and joint position sense during a 12-day high altitude trek: The British Services Dhaulagiri medical research expedition. Plos One. 2018;13(1):e0190919.
  9. Wittenberg E, Thompson J, Nam CS, Franz JR. Neuroimaging of human balance control: a systematic review. Front Hum Neurosci. 2017; 11:170.
  10. Shouhani M, Jalilian M, Parsaei S, Modara F, Seidkhani H. The Effect of unilateral and bilateral electrical stimulation of the brain on improving the balance of the elderly. J Age. 2020;15(3):312-23. (In Persian).
  11. Takai H, Tsubaki A, Sugawara K, Miyaguchi S, Oyanagi K, Matsumoto T et al. Effect of transcranial direct current stimulation over the primary motor cortex on cerebral blood flow: a time course study using near-infrared spectroscopy. In Oxygen Transport to Tissue XXXVII. New York: Springer; 2016, pp. 335-41.
  12. Polanía R, Paulus W, Antal A, Nitsche MA. Introducing graph theory to track for neuroplastic alterations in the resting human brain: a transcranial direct current stimulation study. Neuroimage. 2011;54(3):2287-96.
  13. Ruohonen J, Karhu J. tDCS possibly stimulates glial cells. Clin Neurophysiol. 2012;123(10):2006-9.
  14. Oberle K, Ketcham CJ. Cerebellar transcranial direct current stimulation and dual-task performance. Neurol & Neuroth. 2018;3(1):6.
  15. Steiner KM, Enders A, Thier W, Batsikadze G, Ludolph N, Ilg W et al. Cerebellar tDCS does not improve learning in a complex whole body dynamic balance task in young healthy PloS One. 2016;11(9):e0163598.
  16. Flöel A, Suttorp W, Kohl O, Kürten J, Lohmann H, Breitenstein C et al. Non-invasive brain stimulation improves object-location learning in the elderly. Neurobiol Aging. 2012;33(8):1682-9.
  17. Ghorbanian B, Saberi Y, Rasouli M. The effect of pilates training and electrical stimulation on motor and cognitive function of women with multiple sclerosis. Neurosci J Shefa Khat. 2019;8(1):63-76. (In Persian).
  18. Sun MK, Alkon DL. Carbonic anhydrase gating of attention: memory therapy and enhancement. Trends Pharmacol Sci. 2002;23(2):83-9.
Sport Physiology
Volume 15, Issue 58
July 2023
Pages 45-68

  • Receive Date 25 May 2023
  • Revise Date 14 November 2023
  • Accept Date 25 November 2023